Abstract

Objective The aim of this analysis was to investigate the relationship of statins with institutionalisation and death in older men
living in the community, accounting for frailty.

Design Prospective cohort study.

Setting Community-dwelling men participating in the Concord Health and Ageing in Men Project, Sydney, Australia.

Participants Men aged ≥70 years (n=1665).

Measurements Data collected during baseline assessments and follow-up (maximum of 6.79 years) were obtained. Information regarding statin
use was captured at baseline, between 2005 and 2007. Proportional hazards regression analysis was conducted to estimate the
risk of institutionalisation and death according to statin use (exposure, duration and dose) and frailty status, with adjustment
for sociodemographics, medical diagnosis and other clinically relevant factors. A secondary analysis used propensity score
matching to replicate covariate adjustment in regression models.

Results At baseline, 43% of participants reported taking statins. Over 6.79 years of follow-up, 132 (7.9%) participants were institutionalised
and 358 (21.5%) participants had died. In the adjusted models, baseline statin use was not statistically associated with increased
risk of institutionalisation (HR=1.60; 95% CI 0.98 to 2.63) or death (HR=0.88; 95% CI 0.66 to 1.18). There was no significant
association between duration and dose of statins used with either outcome. Propensity scoring yielded similar findings. Compared
with non-frail participants not prescribed statins, the adjusted HR for institutionalisation for non-frail participants prescribed
statins was 1.43 (95% CI 0.81 to 2.51); for frail participants not prescribed statins, it was 2.07 (95% CI 1.11 to 3.86) and
for frail participants prescribed statins, it was 4.34 (95% CI 2.02 to 9.33).

Conclusions These data suggest a lack of significant association between statin use and institutionalisation or death in older men. These
findings call for real-world trials specifically designed for frail older people to examine the impact of statins on clinical
outcomes.